Part 5APharmaceutical Reimbursement

Part 5A—Pharmaceutical Reimbursement

Definitions: 

  In this Part:

member means a person eligible under the MRCA Pharmaceutical Benefits Scheme for the payment known as the “pharmaceutical reimbursement”.

veteran means an Eligible Person eligible for payment of a pharmaceutical reimbursement.

  The Commission may, subject to this Part, accept financial responsibility for the pharmaceutical reimbursement.

Note: if the Commission accepts financial responsibility for a cost in relation to the provision of a Pharmaceutical benefit to an Eligible Person, the Commonwealth pays that cost.

  The pharmaceutical reimbursement is a financial amount that would compensate an Eligible Person for out‑of‑pocket expenses:

 (a) that the person incurred in respect of a Pharmaceutical benefit provided under this Scheme; or

 (b) that the person incurred in respect of a Pharmaceutical benefit provided other than under this Scheme but provided on or from a date when the Commission accepted liability to provide treatment to the person under the Act.

Note 1: under the Acts Interpretation Act 1901 words in the singular number (e.g. Pharmaceutical benefit) include the plural and words in the plural number include the singular.

Note 2: paragraph (b) covers what are known as “MEPIs” (Medical Expenses Privately Incurred).  Under the Act eligibility for treatment can be backdated for 3 months before a claim for pension is received and treatment costs incurred in that period e.g. co‑payments for Pharmaceutical benefits, may be met by the Department.

  The amount of pharmaceutical reimbursement is worked out under 39.

36  Eligibility for Payment of Pharmaceutical Reimbursement

 (1) To be eligible for payment of the pharmaceutical reimbursement an Eligible Person must:

 (a) have rendered qualifying service; and

 (b) suffer from an accepted disability; and

 (c) receive pension under Part II or Part IV of the Act in  respect of the accepted disability.

 (2) For the purposes of (1)(c), a person is taken to receive pension under Part II or Part IV of the Act if, apart from section 25A, Division 5A of Part II and section 74 of the Act, the person would receive a rate of pension greater than nil.

37  Calculation of annual value of pharmaceutical allowance component of Pension Supplement, Veterans Supplement, MRCA supplement

  The annual value of the pharmaceutical allowance component is calculated as follows:

 (a) for a veteran in receipt of veterans supplement or MRCA supplement at different times throughout the year, the amount of $6 per fortnight, indexed according to section 198F of the Act: